CEA is a surgical procedure used to correct carotid stenosis (narrowing of the carotid artery lumen by atheroma), used particularly when this causes symptoms which will lead to medical problems, such as transient ischemic attacks (TIAs) or cerebrovascular accidents (CVAs, strokes). Regardless of the symptoms, if a person’s carotid artery is clogged by the plaque by 60% or greater; treatment is required to prevent a stroke. Endarectomy is the removal of plaque from the artery walls. Angioplasty and stenting (Endovascular) of the carotid is an alternative treatment to a CEA.
Neuro checks will be done q 1 hour with VS X 2, q 2 hr. X 2, and then q 4 hr.
During Neuro checks assess for mental orientation and level of consciousness.
Assess Cranial Nerves-
Hypoglossal- ability to position tongue midline. If tongue deviates to one side, call the surgeon. Assess hypoglossal pharyngeal nerve for swallowing ability
Spinal Accessory- bilaterally raise arms and sustain for 3 seconds
Assess pupillary reaction during neuro checks. Assess all four extremities for equal strength, movement, and sensation.
NURSING CONSIDERATIONS CONTINUED:
Assess that airway is intact. Assess neck for edema and hematomas. Take note of anyu tracheal deviation, respiratory distress (stridor), drooling, and problems swallowing. Assess breath sounds. Call surgeon immediately for any airway issues.
Assess incision for approximation of edges and any bleeding, drainage or redness. Assess for hematoma at neck- Call if increase edema or grapefruit size hematoma.
Assess Vital Signs as ordered. Due to manipulation of baroreceptors close to the carotid artery, Blood Press control is very important and must be within normal parameters. Call if SBP > 180 or DBP < 100.
Evaluate heart rhythm for any arrhythmias.
OTHER IMPORTANT TIPS:
Patients with local nerve block anesthesia may have numbness after surgery extending into the neck/throat area, shoulder and down to the nipple line on side of surgery. This should wear off in 6-8 hours after surgery.
If the patient has a head ache after surgery due to reperfusion, give Tylenol. If not relief of headache within 1-2 hours of Tylenol, call surgeon- this may be a sign of an intracranial bleed and will need an US of the neck and a CT of the head to r/o bleed.
Surgeons do not want these patients to receive Lovenox until cleared by them. Administration of Lovenox is associated with high risk of bleeding which could cause respiratory compromise if hematoma develops at incisional site.
Prior to discharge, have patient look into the mirror to see how much swelling is present in the neck area. Tell the patient to notify the surgeon immediately if the swelling enlarges.